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AF | PDBR | CY2012 | PD2012 01299
Original file (PD2012 01299.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XX         BRANCH OF SERVICE: NAVY
CASE NUMBER: PD1201299   SEPARATION DATE: 20020430
BOARD DATE: 20130417


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Petty Officer Third Class/E-4 (CT03/Cryptologic Technician Communications), medically separated for T12 anterior wedge compression fracture. The CI incurred the injury in a severe motor crash. The CI did not improve adequately with treatment to meet the physical requirements of her Rating or satisfy physical fitness standards. She placed on limited duty [LIMDU]/placed on light duty and referred for a Medical Evaluation Board (MEB). T12 anterior wedge compression fracture and increased kyphosis through her thoracic spine conditions, identified in the rating chart below, were identified and forwarded by the MEB. The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the T12 anterior wedge compression fracture as unfitting, rated 10%, with application of the SECNAVINST 1850.4D. The increased kyphosis through her thoracic spine was related to the unfitting T12 compression fracture but not separately ratable (Category 2). The PEB also considered posttraumatic stress disorder and determined it to be not unfitting. The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: The CI elaborated no specific contention in her application.


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The service ratings for unfitting conditions will be reviewed in all cases. The T12 anterior wedge compression fracture and Category 2 thoracic kyphosis meet the criteria prescribed in DoDI 6040.44 for Board purview; and are is addressed below. The other requested conditions are not within the Board’s purview. The remaining conditions rated by the VA at separation and listed on the DA Form 294 application are not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records (BCNR).


RATING COMPARISON :

Service IPEB – Dated 20020225
 VA (~1 Mo. Post-Separation) – All Effective Date 20020501
Condition
 Code Rating Condition Code Rating Exam
T12 Anterior Wedge Compression Fracture 5285 -5291 10% Residual T12 Fracture with Low Back Strain 20% 5299-5235 20031113
Increased Kyphosis CAT II
PTSD CAT III Post Traumatic Stress Disorder 10% 9411 20031104
↓No Additional MEB/PEB Entries↓
 0% X 1 / Not Service-Connected 1 # 20031113
Combined: 10%
 Combined: 40%


ANALYSIS SUMMARY:

T12 Anterior Wedge Compression Fracture Condition. The CI sustained a compression fracture of the T12 vertebra, in a motor vehicle crash, in August 1999. A magnetic resonance image scan of the thoracic spine, on 10 May 2001, noted a 40% compression deformity of the T12 vertebral body. This deformity resulted in focal kyphosis of the thoracic spine centered at the level of T12. The remainder of the thoracic spine demonstrated normal configuration and findings. Spine surgery was not advised. The MEB physical examination, dictated 9 October 2001, recorded back flexion of 80 degrees. There was tenderness to palpation. The CI was able to walk on toes and heels and reflexes were normal. A neurology examination, in November 2001, documented normal gait, strength, reflexes, and sensation. The MEB narrative summary, 11 October 2001, reported continued back pain related to the residual increase thoracic kyphosis resulting from the T12 compression fracture. This pain limited her ability to perform her military duties. At the VA Compensation and Pension (C&P) examination on 13 November 2003, 18 months after separation, the CI reported chronic mid and lower back pain for which she used pain medications and rest for treatment intermittently. On examination, posture and gait were normal. Back flexion was 80 degrees and extension 20 degrees with no additional limitation on repetition. X-rays showed mild to moderate compression fracture at T12 with hyperlordosis and mild levo-convex curvature of the lumbar spine.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the residuals of T12 compression fracture with increased thoracic kyphosis 10% coded 5285-5291 (residuals of vertebral fracture and limitation of dorsal spine motion respectively) based on the Veterans Affairs Schedule of Rating Disabilities (VASRD) guidelines in effect at the time. The initial VA C&P examination and rating decision occurred after the current rating guidelines for diseases and injuries of the spine became effective in September 2003. In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation. The Board notes that the 2002 Veteran Administration Schedule for Rating Disabilities (VASRD) standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004. The Board must correlate the above clinical data with the 2002 rating schedule that was in effect at the time of separation. All Board members agreed the residuals of the T12 vertebral compression fracture warranted a 10% rating under code 5285 (residuals of vertebral fracture) for her clearly demonstrable compression fracture with kyphosis which could be added to an additional ratable limitation of motion. The MEB and C&P examinations provided range of motion for the back generally and not the thoracic (dorsal) spine specifically. The limitation more nearly approximated a slight limitation. Under the code for dorsal spine (thoracic limitation of motion) 5291, a 0% (zero percent) rating is assigned for slight limitation of motion while under the code for lumbar spine limitation of motion a 10% rating is assigned for slight limitation of motion. In accordance with VASRD guidance, ratings should not be assigned for more than one segment by reason of involvement of only the first or last vertebrae of an adjacent segment. T12 is the last segment and only one rating can be assigned for limitation of motion. Also in this case assignment of two ratings would be based on the same limitation of motion and is prohibited by §4.14 (avoidance of pyramiding). The Board noted physical medicine evaluations reporting thoracic and low back pain and concluded use of the 5292 code for limitation of motion of the lumbar spine more nearly described the functional limitation. Under this code, a 10% rating is supported by the examination findings. There was no intervertebral disc syndrome to warrant consideration under code 5293. The Board also considered a rating under 5295, lumbosacral strain, but concluded a rating higher than 10% was not supported by the evidence. The separately listed thoracic kyphosis was a residual of the T12 compression fracture and is subsumed in the rating for the residuals of the T12 compression fracture. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the T12 anterior wedge compression fracture condition (5285-5292).
BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the T12 anterior wedge compression fracture condition, the Board unanimously recommends a disability rating of 20%, coded 5285-5292 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Anterior Wedge Compression Fracture at T12 with pain 5285-5292 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120718, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



        
                           XX
                           Director of Operations
                           Physical Disability Board of Review


 MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
 COMMANDER, NAVY PERSONNEL COMMAND
                                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 10 Jun 13 ICO X
(c) PDBR ltr dtd 20 Jun 13 ICO X
(d) PDBR ltr dtd 12 Jun 13 ICO X
(e) PDBR ltr dtd 20 Jun 13 ICO X

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (e).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

         a. X former USN : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 30 April 2002.

         b. S former USN : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 3 December 2001.

         c. X former USN: Disability retirement with assignment to the Temporary Disability Retired List with a 50 percent disability rating (in accordance with VASRD 4.129) for the period 2 February 2002 through 1 August 2002, with assignment to the Permanent Disability Retired List with a 50 percent disability rating effective 2 August 2002.

         d. X former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 15 December 2003.
        
3. Please ensure all necessary actions are taken, included the recoupment of disability severance pay if warranted, to implement these decisions and that subject members are notified once those actions are completed.



                                                      XX
                                                      Assistant General Counsel
                                                      (Manpower & Reserve Affairs)





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